Comprising about 16% of the US child population, children with special health-care needs (CSHCN) account for nearly 50% of all children's medical expenses. For many of these children, unique barriers to access compound their heavy morbidity burden. Transportation may require special vehicles, equipment and multiple professional attendants. Changes in environment may be distressing. Telemedicine holds profound potential to mitigate geographic and other obstacles that impede healthcare access and increase its financial and human costs. Based on success in developing telemedicine to serve children in childcare and elementary schools, the Health-e-Access Program (HeA) is uniquely positioned to work with programs for CSHCN, parents, and primary care clinicians to optimize telemedicine for CSHCN. Once infrastructure is established and stakeholders gain experience and comfort with telemedicine for the acute problems that generate frequent encounters, we anticipate that stakeholders will recognize and more readily adopt applications for chronic problems. Measurement strategies address incentives for adoption of telemedicine by all major stakeholders. Specific aims are to: (1) establish personal computer- and web-based telehealth networks to address acute care needs of CSHCN in Rochester, NY and in Akron, OH;(2) assess the economic impact of this network on key stakeholders;and (3) determine the technical, clinical, organizational requirements and the incremental costs for system modifications that will be critical in addressing chronic problems of CSHCN. Study #1 will assess the feasibility and acceptability of integrating telehealth for acute problems in CSHCN using 4 CHSCN service organizations in 2 communities and in 14 primary care practices. Study #2 will assess the hypothesis, using medical claims data, that health care use and costs associated with acute medical problems for CSHCN have been reduced, and it will quantify reduction. Study #3 will estimate the economic benefits of Health-e-Access for parents, employers and CSHCN service providers. Study #4 will use qualitative methods, stakeholder surveys and cost analysis to meet the objectives of specific aim #3 Telemedicine models we will further develop and study hold potential to transform access, foster appropriate use, and reduce unnecessary expense. Moreover, by integrating clinicians from the medical home, we promote another cardinal attribute of quality, continuity of care.